{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"AMY   L TRACY","gend":1,"add":"633 ALLENS CREEK ROAD","city":"GLADSTONE","state":"VA","zip":"24553-9998","dob":"1986-10-20","age":"","mstatus":"","insh":"1600578*01","cliId":"","pno":"434\/546-0865","cno":"434\/546-0865","email":"","ename":"","eno":"","pphy":"DAVIS, TABATHA MD","ppno":"434\/263-4000","pcpadd":"4038 THOMAS NELSON HWY","pcpcity":"ARRINGTON","pcpstate":"VA","pcpzip":22922,"pcpcounty":"","pcpid":"","pcpname":"","plan":"OHP","program":"MEDICAID","lob":"M4","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"","madd2":"","madd3":"","mcity":"","mstate":"","mzip":"","pcpfaxno":"434\/263-4160","pcpnpi":""},{"a":{"indx":["1","","","","","","",""],"comment":["","","","","","","",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":[{"a":{"diag":["Z79.899","F11.20","F33.0","O60.14X0","NO DATA","O42.013","Z37.0","O69.1XX0","Z3A.34","Z86.19","Z86.59","Z87.891","Z82.49","Z80.3","O42.913","F33.2","Z79.891","R52.","O47.9","R45.0","F31.2","F41.1","Z23.","O80.","Z3A.00","Z13.32","Z13.89","K43.2","Z30.2","D24.2","Z39.1","N39.0","Z72.0"],"date":["2022-02-23","2021-03-24","2022-07-19","2020-04-06","2022-01-06","2020-04-06","2020-04-07","2020-04-06","2020-04-07","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2020-04-06","2021-02-11","2021-02-11","2020-04-06","2020-04-06","2020-04-06","2021-02-11","2022-11-15","2020-03-06","2020-04-07","2020-04-06","2020-06-01","2020-01-08","2022-10-07","2020-04-07","2022-01-06","2020-04-20","2020-08-24","2022-09-19"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]}}]},{"t":"Covid Screening","q":[{"a":[]}]},{"t":"Self-Assessment and Social History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","65862069730","VENLAFAXINE","CAP 150MG ER","60","Select","Select",""],["","16729013616","CLONAZEPAM","TAB 0.5MG","30","Select","Select",""],["","00603548221","PROPRANOLOL","TAB 10MG","60","Select","Select",""],["","31722099601","HYDROCO\/APAP","TAB 5-325MG","20","Select","Select",""],["","67877021905","CEPHALEXIN","CAP 500MG","12","Select","Select",""],["","16714008210","HYDROXYZ","TAB 25MG","60","Select","Select",""],["","00069541066","VISTARIL","CAP 25MG","90","Select","Select",""],["","68382009810","PAROXETINE","TAB 20MG","30","Select","Select",""],["","00143924920","AMOX\/K","TAB 875-125","20","Select","Select",""],["","12496120803","SUBOXONE","MIS 8-2MG","60","Select","Select",""],["","47781035703","BUPREN\/NALOX","MIS 8-2MG","60","Select","Select",""],["","65862007930","TERBINAFINE","TAB 250MG","42","Select","Select",""],["","29300024716","BUSPIRONE","TAB 30MG","60","Select","Select",""],["","42858050203","BUPRENORPHIN","SUB 8MG","75","Select","Select",""],["","16714043901","NITROFURANTN","CAP 100MG","10","Select","Select",""],["","68382080601","TRAZODONE","TAB 100MG","60","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Review of Systems and Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}